VSG as experimental procedure

Has anyone had any success trying to get coverage for a VSG if it is considered an experimental procedure and not covered by insurance?  I can get a RNY paid for by insurance but prefer VSG and have no medical necessity to have the VSG over the RNY.

I had no medical necessity to have VSG, it was just a preference. My insurance denied it twice and I appealed and had it overturned. I placed my letters and research out on my blog.

I was denied twice for investigational and it was overturned on my second appeal. However, my employer is self funded so in the end they had the last say...and they said yes!

Good Luck! And fight for what you want...do NOT settle

I have Anthem Blue Cross of Ca and they denied me for the same reason... My surgeon did a peer to peer and they denied that. I sent them a huge appeal packet about 3 weeks ago and I am hoping they'll overturn their decision. I also sent an appeal to the California DMHC and just received a letter from them saying they sent my info to the Dept. of Ca. Insurance (I think that's the right name) because I guess it was out of the DMHC'S jurisdiction. We will see what they say.. Keep trying!!!

Yep...same scenerio for me!  I'm in appeal with Anthem and California dept of insurance.  Waiting on my surgeon to sign the IMR certificate.  Geeze this is a long battle.... but worth it!

Keep trying all!!!

I have Aetna and got basically the same story, they wouldn't cover it and all I could do was a 6 month pre op program, get denied, appeal, then probably get denied again. In the end we decided to just pay out of pocket instead of fighting. I would say if the VSG is TRULY what is right for you, to fight or take the route I did if possible. Don't settle for a "second rate" surgery, go for the one that is best for you.